House Republicans will take another crack at repealing Obamacare on Thursday in a high-stakes vote on legislation that would dramatically revamp the health care system and will serve as a major test for the GOP Congress and the Trump administration.
The Republican bill, hotly contested and highly controversial, was the subject of 11th-hour negotiations and last-minute sweeteners, as GOP leaders scrambled for enough votes to push it through the House and send it to the Senate.
“There’s been a lot of drama, a little bit of trauma along the way,” said Rep. Tom Cole of Oklahoma, a member of the House GOP leadership. He said the vote count is “fairly close,” but he expressed confidence the bill would pass.
Cole and other Republicans shrugged off questions Thursday morning about whether they were allowing lawmakers enough time to read the bill, debate it, and understand its impact.
“It’s a false narrative to say that this has been a rushed process,” said Rep. Larry Buschon, R-Ind., who noted that Republicans have been debating and drafting bills to repeal the Affordable Care Act for more than six years.
The current House bill would not fully repeal the 2010 Affordable Care Act, but it would kill major elements of that Democratic law. For example, the American Health Care Act would nix the requirement that most Americans purchase insurance, but it would keep in place a provision allowing younger Americans to stay on their parents’ health plans until age 26.
The Republican proposal would repeal the ACA’s tax credits, which are based on income and the cost of health insurance in their local market, and replace those with less generous tax credits based on age.
The most contentious element centers on how to deal with patients who have pre-existing conditions, such as cancer, asthma, or diabetes. The Affordable Care Act bars insurance companies from discriminating against those with pre-existing conditions. The GOP bill would weaken that protection by allowing states to seek a waiver for insurance companies to charge people with pre-existing conditions higher premiums than other consumers.
In an effort to woo moderate Republicans who feared that would put insurance costs out of reach for many sick patients, GOP leaders and the White House agreed to include an extra $8 billion to help patients with existing health problems — a sum that critics said was far short of what would be needed to cover the expenses of patients with chronic health conditions.
That tweak won over several key holdouts and gave the GOP much-needed momentum for the bill just as the White House ratcheted up pressure for a House vote this week.
“I support the bill with this amendment,” said Rep. Fred Upton, R-Mich., after meeting with President Trump at the White House on Wednesday morning about his proposal to beef up funding to help individuals with pre-existing conditions. Upton is an influential player on health care policy, and he had previously opposed the bill amid concerns it would undermine protections for those with pre-existing conditions.
Another holdout, Rep. Billy Long, R-Mo., also switched from a “no” to a “yes” after meeting with Trump and working with Upton on his amendment. Long said he and Upton “sold” Trump on their amendment and agreed to switch their votes after he committed to support it.
But the measure still faces fierce resistance.
A bevy of patient advocacy groups, including the American Heart Association and the American Cancer Society, strongly opposed the bill despite the tweaks offered by Upton and others. In a letter urging lawmakers to reject the proposal, 10 health organizations said the measure would undermine key patient safeguards, lead to higher out-of-pocket expenses, and jeopardize coverage for millions of Americans.
“This bill is fundamentally harmful to patients,” the letter stated.
As the House opened debate on the issue, Democrats said the measure would unravel consumer protections and put Americans back at the mercy of the insurance industry.
“The Republican health care bill is reckless and heartless,” said Rep. Rosa DeLauro, D-Conn. “It will have threatening consequences for millions of Americans. It will cost lives.”
Republicans strongly defended the bill, noting that under the Affordable Care Act, premiums have skyrocketed and many insurers have withdrawn from the state and federal exchanges, leaving consumers with high costs and scarce options.
“We are saving health care,” Rep. Chris Collins, R-N.Y., said as he and other Republicans left a closed-door GOP meeting on the measure.
With Democrats unified against the measure, GOP leaders can only lose about 22 Republicans and still pass the bill. The proposal has been a tug-of-war between the moderate and conservative factions inside the House Republican Conference during weeks of intense negotiations and embarrassing setbacks.
By the count of various news outlets, about 20 lawmakers said they’d vote “no” as of Wednesday afternoon and about two dozen others remained undecided, but the tallies remained highly fluid as House leaders and President Trump lobbied individual holdouts and won over converts.
As they left their Thursday morning meeting, Republicans expressed confidence they would have enough support to pass the measure, although the vote could be a down-to-the-wire squeaker. Even if the House approves the bill, it faces uncertain prospects in the Senate. Some Senate Republicans are lukewarm about the House bill, and Senate Democrats are fiercely opposed.
“Its chances for survival in the Senate are small,” said the Senate’s top Democrat, Chuck Schumer of New York, on Wednesday.